How Chronic Plaque Psoriasis Is Treated

Prescriptions, over-the-counter products, and home remedies

Medically reviewed by Lindsay Cook, PharmDMedically reviewed by Lindsay Cook, PharmD

Chronic plaque psoriasis, also known as psoriasis vulgaris, may be treated with medications including topical ointments, light therapy, and prescription medications. These treatments help remove scales and prevent skin cells from growing too fast.

While there isn't a cure for chronic plaque psoriasis, these treatments, along with skincare and lifestyle changes, can also help you manage the condition.

This article will go over the different treatment options for chronic plaque psoriasis.

Learn More: What Causes Chronic Plaque Psoriasis?

Prescriptions for Chronic Plaque Psoriasis

Topical corticosteroids (steroids) are the most effective treatment for mild plaque psoriasis. However, since it is an autoimmune disorder, chronic plaque psoriasis may need more treatment than just steroids.

In some cases, the body’s autoimmune response will need to be quieted to prevent more harm. Providers can prescribe drugs that target the immune response either as a whole (systemic) or in part (localized).

Topical Corticosteroids

Topical corticosteroids can be the only treatment needed for people with mild chronic plaque psoriasis. The drugs can also be used with other treatments in people with moderate to severe cases.

Topical steroids are available by prescription as well as over-the-counter (OTC) in the form of lotions, creams, ointments, shampoos, foams, and sprays.

Before prescribing a topical steroid, your dermatologist will consider the location and severity of your chronic psoriasis plaques. For plaques on the face or genitals, a lower-strength preparation might be prescribed, while a stronger (medium- to high-potency) steroid can be used on other parts of the body.

Lexette (halobetasol propionate) and Ultravate (halobetasol propionate) are two topical corticosteroids that are approved for use by the U.S. Food and Drug Administration (FDA). Lexette is a foam that's ideal for scalp psoriasis. Ultravate is a cream product.

Takeaway

Overusing topical corticosteroids or using them for a long time can lead to skin atrophy (thinning), which may not be reversible.

Learn More: The Best Topical Steroid Creams for Psoriasis

Non-Biologic Drugs

Chronic plaque psoriasis is commonly treated with three non-biologic drugs (made or synthesized in the lab):

• Methotrexate is an immune-suppressive drug that has been around for more than 50 years. It dampens the immune response as a whole. It is a first-line treatment for moderate to severe plaque psoriasis. Side effects range from hair loss and fatigue to liver and bone marrow damage (toxicity). You will need occasional blood tests to make sure you do not have complications while you are having the treatment.

• Cyclosporine is an immune-suppressive drug that is similar to methotrexate. It is used when psoriasis is either very severe or has not responded to at least one other systemic drug. Cyclosporine works quickly, but you will need frequent monitoring for side effects like high blood pressure and kidney impairment.

• Otezla (apremilast) was approved in 2014 as a treatment for psoriasis and psoriatic arthritis. Otezla works by blocking phosphodiesterase-4 (PDE4), which regulates cellular inflammation. While Otezla is well-tolerated by most people, it can cause side effects like diarrhea, nausea, or headaches when first started. Less commonly, people may have weight loss or signs of depression.

• Zoryve (roflumilast) is a topical cream that works by blocking the enzyme PDE4 which regulates cellular inflammation. Zoryve is approved for the treatment of plaque psoriasis in people 6 years of age and older. Zoryve may cause side effects such as diarrhea, headache, insomnia, and nausea.

Learn More: Taking Otezla For Psoriasis

Biologic Drugs

Biologic drugs, made from human or animal proteins, have been approved to treat moderate to severe chronic plaque psoriasis.

Biologics target a specific part (component) of the immune response rather than the immune system as a whole.

Biologics are usually prescribed for people with moderate to severe psoriasis who have not been helped by other treatments. They can be given either by injection or through a vein (intravenously).

Drugs that target one of two components of the immune response include:

• TNF inhibitors like Humira (adalimumab), Enbrel (etanercept), and Remicade (infliximab) block tumor necrosis factor (TNF), a signaling protein involved in systemic inflammation.

• Human monoclonal antibodies like Stelara (ustekinumab), Cosentyx (secukinumab), Illumya (tildrakizumab), Siliq (brodalumab), Taltz (ixekizumab), Skyrizi (risankizumab-rzaa), and Tremfya (guselkumab) block interleukin, a protein that helps regulate the immune response.

• Janus kinase (JAK) inhibitors, like Sotyktu (deucravacitinib), block tyrosine kinase, a protein involved with the immune response and cell signaling.

Common side effects of biologics include injection site pain, respiratory infections, and flu-like symptoms. In rare cases, certain cancers and neurological disorders (e.g., seizures and multiple sclerosis) may develop.

Takeaway

Biologic drugs can affect your body’s immune response and increase your risk for infections. Make sure that any cuts, sores, burns, or signs of infection are treated by your provider.

Supportive Medications

Other prescription drugs can support the primary treatment of chronic plaque psoriasis. These include:

• Anthralin was once the gold standard of psoriasis treatment, but it’s been replaced by more effective (and less messy) topical treatments. Anthralin is still used today if other standard medications have not worked.

• Dovonex (calcipotriene) is a synthetic vitamin D3 analog first introduced in the 1990s to treat chronic plaque psoriasis. It is believed to improve symptoms by calming the overproduction of keratinocytes in the skin. Other vitamin D3 analogs include calcitriol, tacalcitol, and the co-formulated drug Taclonex (which combines calcipotriene with the topical steroid betamethasone).

• Soriatane (acitretin) is an oral retinoid that comes from vitamin A. It can slow skin cell production and reduce inflammation. It is approved for the treatment of severe psoriasis. The drug can have side effects like lip inflammation, hair loss, and drying of the eyes, nose, and mouth. This medication should not be used during pregnancy.

• Tazorac (tazarotene) is a topical retinoid used to treat mild to moderate psoriasis. It is also marketed under the brand names Avage and Fabior. Possible side effects include skin irritation and sun sensitivity. Tazorac should be avoided during pregnancy because there is a risk of birth defects.

Takeaway

In May 2022, the FDA approved Vtama (tapinarof) cream, 1%—a new type of topical medication—for the treatment of mild, moderate, and severe chronic plaque psoriasis in adults. Vtama is the first and only FDA-approved non-steroidal topical medication in its class.

The cream is applied once daily and works by activating aryl hydrocarbon receptors in the skin to reduce inflammation.

Studies have shown this treatment to be effective and safe for use on multiple body sites—including sensitive skin areas.

Common side effects include itching, folliculitis, skin rash, and headache.

Learn More: A New Non-Steroidal Psoriasis Cream Is Making Remission Possible

Off-Label Treatments

It is not uncommon for providers to prescribe a drug for purposes other than what it was approved for. This is called "off-label" treatment, and the practice is often supported by medical research but hasn’t gone through the large-scale human trials required by the FDA.

Drugs commonly used as off-label treatments for chronic plaque psoriasis include:

• Cimzia (certolizumab) and Simponi (golimumab) are TNF inhibitors like Humira and Enbrel that are used to treat many autoimmune diseases. They have yet to receive FDA approval for psoriasis.

• Calcineurin inhibitors like Protopic (tacrolimus) and Elidel (pimecrolimus) work by blocking a chemical needed to trigger the inflammation. They are approved to treat eczema but are often used off-label to treat mild to moderate psoriasis.

• Orencia (abatacept) blocks a type of white blood cell (T-cell) that the immune system uses to start an inflammatory response. It is approved for the treatment of psoriatic arthritis, but not psoriasis.

Learn More: What to Know Before Taking Cimzia

Over-the-Counter Treatments for Chronic Plaque Psoriasis

Over-the-counter (OTC) products are also available to treat chronic plaque psoriasis. However, some can be harsh on your skin or interact with prescribed treatments, so it is important to talk to your dermatologist before you use them.

Some common OTC treatments for chronic plaque psoriasis include:

• Coal tar has been used to treat psoriasis for more than 100 years. Coal tar is available without a prescription and can be found in a variety of preparations, including shampoos, ointments, lotions, creams, and foams. While soothing, some of the products can be messy and can stain fabric.

• Salicylic acid is a peeling agent that can be used to soften and remove flaking skin. It is an ingredient in a variety of moisturizing creams, lotions, and ointments. Do not use more than one salicylic product at the same time. Do not put products with salicylic acid on more than 20% of your body. You could absorb too much which can be toxic.

• Topical anti-itch remedies have ingredients in them that are approved by the FDA to treat itching (pruritus). Anti-itch agents include calamine, hydrocortisone, camphor, diphenhydramine hydrochloride, benzocaine, and menthol. While useful, some of these products may increase skin dryness and flaking.

Related: The Best OTC Psoriasis Treatments

Phototherapy

Sunlight can help with the symptoms of chronic plaque psoriasis, but too much exposure to the sun can lead to sunburns and actually make psoriasis symptoms worse. A safer option for people with psoriasis who have not been helped by medications alone is UV light therapy (phototherapy).

Here are a few examples of how phototherapy is used for chronic plaque psoriasis:

• Ultraviolet B (UVB) radiation gets into the skin and slows the overproducing of skin cells. These treatments can be done in a provider’s office or by yourself at home using a special unit. You can buy home UVB units online, but they should not be used without talking to your dermatologist. If overused or used the wrong way, home UV treatments can make psoriasis worse. Even when used correctly, your skin may get worse before it gets better, but doing the treatment consistently usually gives the best results.

• Psoralen + UVA (PUVA) combines UVA radiation with a light-sensitizing drug called psoralen. PUVA is more effective for treating stable plaque psoriasis than it is for acute flares.

• Excimer laser therapy uses a focused beam of UVB radiation to treat smaller lesions in people with mild to moderate psoriasis.
  

Learn More: What Is Phototherapy for Psoriasis?

Home Remedies

The goal of home therapies for chronic plaque psoriasis is to get relief from itchiness, burning, and discomfort, as well as to gently remove accumulated cells without harming the skin.

Some home remedies you may want to try include:

• Therapeutic baths made with Epsom salt, mineral oil, milk, oatmeal, or olive oil, can soothe the skin while gently lifting scales from the outer layer (epidermis).

• Fragrance-free moisturizers, such as petroleum jelly, aloe vera gel, or mineral oils, can help with the shedding of cells while also trapping moisture in the skin. These emollient-rich lotions should be put on after a bath to counteract moisture loss.

• Natural sunlight can slow the overproduction of skin cells, but exposure needs to be limited to around 10 minutes a day. You can gradually increase that time but always do so while you are wearing protective clothing and a minimum SPF 30 sunscreen.

Takeaway

A holistic psoriasis treatment approach includes regular exercise, stress reduction, a low-fat diet rich in omega-3 fatty acids, and avoiding alcohol and cigarettes.

Learn More: Psoriasis Diet: What to Eat

Skin Care

With chronic plaque psoriasis, good skin care is essential. You can start by avoiding deodorant soaps, exfoliating scrubs, and alcohol-based astringents and cleansers, as these products can inflame sensitive skin and trigger a flare.

Other key skin care tips for managing chronic plaque psoriasis include:

• Cleanse and moisturize your skin just once a day to avoid drying.

• Wash your skin with lukewarm, not hot, water. Hot water increases inflammation and can strip away your body's natural oils.

• Choose a mild soap or cleanser that’s been formulated for psoriasis.

• Use your hands or a soft cloth to lather up. Avoid using loofahs, pumice stones, or anything that can scratch or irritate your skin.

• Do not over-soap your skin, as this can make your skin dry. Only soap the parts of your body that need it.

• In the dry, winter months, switch from a lighter lotion to a heavier moisturizing cream to compensate for the loss of humidity in the cold air.

• Avoid perfumes and colognes that contain alcohol.

• While you should generally avoid makeup if you have facial psoriasis, you can try using a skin-safe concealer like Dermablend or Covermark to cover up plaques and scars.

Learn More: How Psoriasis Looks on Different Skin Tones

Summary

Chronic plaque psoriasis can be managed with a variety of prescription and OTC treatments. Although the condition is not curable, medications, home remedies, light therapy, and skincare can all help you manage flare-ups. You may need to use more than one treatment to effectively manage your psoriasis over the long-term. Check with your dermatologist on what treatment is best for your particular condition.

Frequently Asked Questions

What type of doctor treats chronic plaque psoriasis?

Chronic plaque psoriasis is typically treated by both a dermatologist and a rheumatologist.

How is chronic plaque psoriasis treated?

Chronic plaque psoriasis is treated with a combination of topical corticosteroids, immunosuppressants, and other prescription medications and over-the-counter products. Self-care, including skin care, is also an important part of managing plaque psoriasis.

How can I prevent chronic plaque psoriasis outbreaks?

In addition to taking your medications, lifestyle habits like eating a nutritious diet, getting regular exercise, avoiding alcohol and cigarettes, and reducing stress can help strengthen your immune system and prevent flares of chronic plaque psoriasis.

Taking care of your skin is also an important part of self-care when you have psoriasis. Avoid harsh soaps, exfoliating scrubs and loofahs, alcohol-based cleansers, and hot water, and keep your skin moisturized and protected against irritations, injury, and insect bites.

Read Next: Tips for Living With Chronic Plaque Psoriasis

Read the original article on Verywell Health.